Abstract

Background

There has been a relentless increase in emergency medical admissions in the UK over
recent years. Many of these patients suffer with chronic conditions requiring continuing
medical attention. We wished to determine whether conventional outpatient clinic follow
up after discharge has any impact on the rate of readmission to hospital.

Methods

Two consultant general physicians with the same patient case-mix but markedly different
outpatient follow-up practice were chosen. Of 1203 patients discharged, one consultant
saw twice as many patients in the follow-up clinic than the other (Dr A 9.8% v Dr
B 19.6%). The readmission rate in the twelve months following discharge was compared
in a retrospective analysis of hospital activity data. Due to the specialisation of
the admitting system, patients mainly had cardiovascular or cerebrovascular disease
or had taken an overdose. Few had respiratory or infectious diseases. Outpatient follow-up
was focussed on patients with cardiac disease.

Results

Risk of readmission increased significantly with age and length of stay of the original
episode and was less for digestive system and musculo-skeletal disorders. 28.7% of
patients discharged by Dr A and 31.5 % of those discharged by Dr B were readmitted
at least once. Relative readmission risk was not significantly different between the
consultants and there was no difference in the length of stay of readmissions.

Conclusions

Increasing the proportion of patients with this age- and case-mix who are followed
up in a hospital general medical outpatient clinic is unlikely to reduce the demand
for acute hospital beds.